经后路椎体次全切除三柱重建治疗不稳定性胸、腰椎单发爆裂骨折  

Subtotal corpectomy and three-column reconstruction via single posterior approach for the treatment of unstable thoracic or lumbar Fracture

作　　者：洪正华[1] 陈海啸[1] 王章富[1] 洪华兴[1] 张传毅[1] 陈伟富[1] 陈国富[1] 洪盾[1] 林列[1] 

机构地区：[1]台州医院骨科,浙江临海317000

出　　处：《中华骨科杂志》2011年第12期1309-1313,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨经后路椎体次全切除三柱重建治疗不稳定性胸、腰椎单发爆裂型骨折的临床疗效。方法2005年1月至2009年3月，采用该术式治疗不稳定性胸、腰椎单发爆裂型骨折患者30例，男22例，女8例；年龄17-58岁，平均36岁。手术采用后正中入路，切除伤椎的一侧椎板、椎弓根及关节突，创建后外侧通道，然后行椎体次全切，椎间植入钛网或人工骨笼，后路椎弓根内固定重建脊柱三柱的稳定性。随访时进行X线和CT检查，比较术前、术后和随访时的伤椎高度、Cobb角、椎管狭窄分级及植骨融合情况。结果30例均获得随访，平均随访28个月（18-48个月）。手术后胸、腰椎生理曲度恢复满意，Cobb角及伤椎高度与术前相比得到明显改善；椎管狭窄分级，术前2级8例、3级22例，术后均为0级；神经功能明显恢复，术后Frankel分级：A级1例、B级1例、C级3例、D级9例、E级16例。结论经后路椎体次全切除及三柱重建治疗不稳定性胸、腰椎单发爆裂型骨折是安全、有效的方法，并且具备前后联合入路手术的优势，为治疗不稳定胸、腰椎单发爆裂型骨折提供一个理想的选择。Objective To investigate the clinical effects of subtotal corpectomy and three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture. Methods Between January 2005 and March 2009, 30 patients with unstable thoracolumbar fractures were involved, among whom there were 22 males and 8 females, aged 17-58 years old （36 on average）. There were 16 cases of falling injury and 14 cases of vehicle accident injury. The laminae of the injured vertebrae and adjacent vertebrae were exposed through posterior midline incision. Unilateral lamina and pedicle of the injured vertebra and relevant facet joints were resected to build a posterolateral working pathway after pedicle screws were put into the upper and lower vertebrae. Through this pathway a subtotal corpectomy was done and a titanium mesh or artificial bone with suitable size was implanted.The titanium mesh or artificial bone was fastened by compressing the pediele screws. The outcome of treatment was assessed by evaluation of the Cobb angle restoration, the reduction of canal compromise, and the fusion of implant between the upper and lower vertebrae. Results Thirty patients were followed up for an average of 28 months. The thoracolumbar vertebral curvature had fully recovered; The Cobb＇s angle, spinal canal index and the intervertebral space height had improved remarkably; The Frankel grade scores： A in 1 case, B in 1 case, C in 3 cases, D in 9 cases, and E in 16 cases. No patients developed such complications as break or mobilization of the pedicle screw. Conclusion Subtotal corpectomy and three-column reconstruction through single posterior approach is a safe and effective technique for the treatment of unstable thoracolumbar fracture.

关 键 词：胸椎 腰椎 脊柱骨折 减压术 外科 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]